Aortic aneurysm & dissection

Your aorta is the largest artery in your body. It starts at the heart, arches up over the top, and then runs down through your chest and belly, carrying oxygen-rich blood to everything below. Because it handles the full force of each heartbeat, the aorta has to be both strong and flexible.

An aortic aneurysm is a balloon-like bulge in a weakened section of the aortic wall. Over time, blood pressure can push that weak spot outward, like a worn patch on a garden hose. Many aneurysms grow slowly and cause no symptoms for years.

An aortic dissection is different. The aortic wall is made of layers. In a dissection, a tear lets blood force its way between the layers, splitting them apart. This is a medical emergency that needs immediate hospital care.

The two conditions are linked: a large aneurysm raises the risk of a dissection or a rupture (a full burst of the wall). The good news is that when an aneurysm is found early, doctors can watch it carefully and step in before serious problems develop. This guide covers both the slow-moving, plannable side of aortic disease and the emergency side, so you understand the full picture.

Doctors describe aortic problems mainly by where they sit and what is happening to the wall.

Aneurysms by location

• Abdominal aortic aneurysm (AAA) — a bulge in the part of the aorta that runs through the belly. This is the most common type.
• Thoracic aortic aneurysm (TAA) — a bulge in the part of the aorta inside the chest. This can affect the aortic root (where the aorta leaves the heart), the ascending aorta, the arch, or the descending chest aorta.
• Thoracoabdominal aneurysm — a bulge that spans both the chest and the belly.

Dissection by location (Stanford system)

For a dissection, doctors most often use the Stanford classification, because it guides treatment:

• Type A — the tear involves the ascending aorta near the heart. This is immediately life-threatening and usually needs emergency surgery.
• Type B — the tear is in the descending aorta, beyond the arch. Depending on the situation, this may be treated with medicines first, or with a procedure.

An older system, the DeBakey classification, divides dissections into types 1, 2 and 3 based on exactly which sections are involved. Your team will use whichever labels help them plan your care.

Aortic disease usually develops because the wall of the aorta gradually weakens. Often there is no single cause, but several well-recognised factors raise the risk. Knowing them helps you and your doctor decide whether checking your aorta makes sense.

Things that increase risk

• High blood pressure — the single most important risk factor for dissection, because it constantly stresses the wall.
• Smoking — current or past smoking is strongly linked to abdominal aortic aneurysm in particular.
• Older age — risk rises with age; abdominal aneurysms are most common in people over 65.
• Being male — men are affected more often than women.
• High cholesterol and atherosclerosis — fatty build-up that stiffens and damages arteries.
• Family history — having a close relative with an aortic aneurysm or dissection.
• Inherited connective tissue conditions — such as Marfan syndrome or Ehlers-Danlos syndrome, which can weaken the aortic wall.
• Bicuspid aortic valve — a heart valve with two flaps instead of three, present from birth.
• Chest injury, cocaine or amphetamine use, and (rarely) certain infections.

Having a risk factor does not mean you will develop an aneurysm. It simply means a conversation with a doctor about screening may be worthwhile.

One of the trickiest things about aortic aneurysms is that most cause no symptoms at all while they are small. Many are found by chance during a scan done for another reason. This silence is exactly why screening matters for higher-risk people.

Possible symptoms of a larger aneurysm

• A deep, constant pain in the belly, chest, or back.
• A pulsing or throbbing feeling in the abdomen.
• For chest aneurysms: a cough, hoarse voice, or trouble swallowing if the bulge presses on nearby structures.

Warning signs of a dissection or rupture — call emergency services now

Seek emergency care immediately if you or someone near you has:

• Sudden, severe, sharp or tearing pain in the chest, upper back, or belly.
• Shortness of breath, fainting, or sudden dizziness.
• A weak, racing pulse, heavy sweating, or signs of a stroke (weakness, slurred speech, drooping face).

These are signs of a life-threatening emergency. Do not wait to see if the pain passes — call your local emergency number straight away.

Because small aneurysms are silent, screening is the main way to catch them early in people at higher risk. Screening simply means checking the aorta with a scan before any symptoms appear.

Abdominal aortic aneurysm screening

The test is a quick, painless ultrasound of the belly. Guidance differs slightly between countries, but the common threads are clear:

• In the United Kingdom, men are invited for a one-time screening ultrasound at age 65.
• In the United States, the US Preventive Services Task Force recommends a one-time ultrasound for men aged 65 to 75 who have ever smoked, and suggests doctors consider it case-by-case for men aged 65 to 75 who have never smoked.
• The evidence is less clear-cut for women, so screening there is decided individually.

Thoracic aortic disease and family screening

There is no routine population screening for chest (thoracic) aneurysms. However, major cardiology guidelines recommend that first-degree relatives (parents, brothers, sisters, children) of someone with a thoracic aneurysm or dissection be offered imaging, and sometimes genetic testing, because the tendency can run in families. If a close relative has had aortic disease, mention it to your doctor.

If an aneurysm is suspected or being monitored, doctors use imaging to measure the aorta precisely and watch for change over time. The measurement (the diameter, in centimetres) is central to every treatment decision.

Common tests

• Ultrasound — the usual first test for the abdominal aorta. Quick, safe, and uses no radiation.
• CT scan (computed tomography) — detailed cross-sectional images. This is the key test in an emergency such as a suspected dissection, because it shows the whole aorta clearly and fast.
• MRI scan — another detailed option, often used for follow-up to limit radiation.
• Echocardiogram — an ultrasound of the heart and the aortic root; a transoesophageal version (a probe passed gently down the food pipe) gives an even closer view.

What the numbers mean

For an abdominal aneurysm, doctors often group size as small (about 3 to 4.4 cm), medium (4.5 to 5.4 cm), or large (5.5 cm and above). They track not only the size but the growth rate. A normal aorta is usually under about 2 to 3 cm, so these figures show how much the wall has stretched. Your team will explain your own measurements in plain terms.

Treatment depends on the type, location, and size of the problem, your overall health, and how fast things are changing. The aim is always to prevent a rupture or dissection while avoiding surgery that is not yet needed. Decisions are best made by a multidisciplinary aortic team — typically cardiac and vascular surgeons, imaging specialists, anaesthetists, and intensive-care doctors working together.

Watchful waiting (surveillance)

Small, stable aneurysms are often simply monitored with regular scans, alongside treating blood pressure and cholesterol and stopping smoking. This is active care, not doing nothing — the goal is to act at the right moment.

Medicines

Controlling blood pressure (often with medicines such as beta-blockers) lowers the stress on the aortic wall. Cholesterol-lowering drugs and stopping smoking are also important parts of the plan.

Procedures and surgery

• Endovascular repair (EVAR for the abdomen, TEVAR for the chest) — a stent-graft (a fabric-lined tube) is guided through a blood vessel in the groin and placed inside the aorta to line the weak section from within. It is less invasive than open surgery.
• Open surgical repair — the surgeon opens the chest or belly, removes the weakened segment, and replaces it with a synthetic graft.
• Hybrid procedures — a combination of open and endovascular techniques for complex cases.

Guidelines often consider repair when an abdominal aneurysm reaches about 5.5 cm, is growing quickly, or causes symptoms. For aneurysms near the heart, experienced centres may consider surgery from around 5.0 to 5.5 cm, and earlier in people with inherited conditions. A Type A dissection is usually an emergency operation, while an uncomplicated Type B dissection may first be managed with medicines. These thresholds are general guides, not personal rules — your surgeon will tailor them to you.

The outlook varies enormously depending on whether an aortic problem is found early and planned for, or whether it presents as an emergency.

When a small aneurysm is found and monitored, many people live for years with careful follow-up, and planned repair has become a well-established treatment. Early detection and modern surgery genuinely change the picture.

A dissection is more serious. Cleveland Clinic notes that aortic dissection is uncommon, affecting roughly 5 to 30 people per million each year, and that an untreated Type A dissection carries a high early risk — about 40% of people with a Type A dissection die immediately from rupture, which is why emergency surgery is so important. At the same time, the same source notes that with prompt treatment and good follow-up, people can live full lives for many years afterwards, although their long-term risk remains higher than average and lifelong monitoring is needed.

It is important to understand that these are population-level figures. They describe groups of people studied over time and are not a prediction for any individual. Your own outlook depends on the location and size of the problem, your general health, how quickly you receive care, and the treatment plan you and your specialists choose together.

Whether you are being monitored or have had a repair, ongoing care is part of life with aortic disease — and most of it fits comfortably into a normal routine.

Regular imaging

You will have scheduled scans (ultrasound, CT, or MRI) to check the aorta's size and stability. After a dissection or repair, imaging may be more frequent at first, then spaced further apart once things are stable.

Daily habits that help

• Keep blood pressure well controlled and take medicines exactly as prescribed.
• Do not smoke — this is one of the most powerful things you can do for your aorta.
• Stay active with steady aerobic exercise such as walking, cycling, or swimming, as your team advises.
• Avoid heavy lifting and intense straining, which can spike blood pressure; ask your specialist what is safe for you.
• Eat a balanced diet, keep a healthy weight, and moderate alcohol.

It is normal to feel anxious about a condition involving the heart's main artery. Talking openly with your care team, and leaning on family or a support group, can make follow-up feel far more manageable.

Some people choose to have planned (non-emergency) aortic care abroad. A true dissection or rupture is an emergency that must be treated at the nearest hospital — but elective monitoring and planned repair can be organised in advance. If you are exploring care in Turkiye, it helps to understand what shapes the overall cost and how to prepare.

Factors that affect the cost of care

• The type of procedure — endovascular repair (EVAR/TEVAR) and open surgery differ in equipment and theatre time.
• The complexity of your anatomy — where the aneurysm sits, its size, and whether several segments are involved.
• The devices used — stent-grafts and synthetic grafts vary.
• Length of hospital and intensive-care stay, and the level of monitoring you need.
• Pre-operative tests and imaging, anaesthesia, and follow-up scans.
• Your general health and any other conditions that affect the plan.

How to prepare your records

• Gather your recent imaging (CT or MRI scans on disc, plus the written reports) — these are essential for an accurate assessment.
• Collect a current medication list, allergy information, and notes on other health conditions.
• Include any family history of aortic disease and prior surgical or cardiology reports.

Because every aorta is different, the only reliable way to understand your options and costs is a personalised assessment. We are happy to arrange a free consultation and request a tailored estimate based on your records.

Turkiye has become a well-known destination for cardiac and vascular care, with hospitals that offer modern imaging, endovascular technology, and experienced surgical teams. As with anywhere in the world, the most important thing is not the country but the quality of the specific centre and team treating you.

What to verify before you commit

• Accreditation — look for internationally recognised hospital accreditation (for example, Joint Commission International) and proper national licensing.
• A dedicated aortic or cardiovascular team — guidelines stress that outcomes are better at centres with experienced surgeons and a coordinated team including imaging, anaesthesia, and intensive care.
• Volume and experience — ask how regularly the centre performs the specific repair you may need.
• Both EVAR/TEVAR and open-surgery capability, so the recommendation is matched to your anatomy rather than to what is available.
• Clear follow-up arrangements — including how imaging and reports will be shared with doctors back home.
• Transparent communication in a language you understand, with a written plan and estimate.

A trustworthy centre will welcome your questions, give you time, and never pressure you. A concierge service can help you compare options, gather the right documents, and coordinate travel and aftercare.

You cannot change your age, sex, or family history, but several everyday choices genuinely lower the risk of aortic disease or slow its progress.

Steps that protect your aorta

• Do not smoke — and if you do, getting support to stop is one of the most valuable actions you can take.
• Keep blood pressure in a healthy range with regular checks and prescribed medicines.
• Manage cholesterol through diet and, where advised, medication.
• Stay physically active and maintain a healthy weight.
• Attend screening if you are eligible, and tell your doctor about any family history of aortic disease.
• Wear a seatbelt to reduce the risk of chest injury.

Second opinions and shared decisions

Decisions about whether and when to operate on the aorta are significant, and it is completely reasonable to seek a second opinion from another qualified specialist or aortic centre. A good doctor will support this. Because thresholds for surgery are guides rather than fixed rules, an open conversation about the balance of risks and benefits — for your specific situation — is the heart of good care. Always discuss your individual circumstances with a qualified cardiologist or vascular surgeon.